Development and validation of model for prediction of placental dysfunction‐related stillbirth from maternal factors, fetal weight and uterine artery Doppler at mid‐gestation

Ashoor, Ghalia; Syngelaki, Argyro; Papastefanou, Ioannis; Nicolaides, Kypros H.; Akolekar, Ranjit

doi:10.1002/uog.24795

Cited by 18 publications

(27 citation statements)

References 38 publications

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“…Gestational age was determined from measurement of fetal crown–rump length at 11–13 weeks or the fetal head circumference at 19–24 weeks of gestation 13,14 . The same study population was used for development and validation of the model based on multivariable logistic regression analysis for prediction of placental dysfunction related stillbirth 1 …”

Section: Methodsmentioning

confidence: 99%

“…The distributions of patient‐specific risks were used to estimate detection rates and FPR from analysis of receiver operating characteristic (ROC) curves. Similarly, patient‐specific risks were estimated using our previously reported logistic regression model for placental dysfunction related stillbirth 1 . The predictive performance for stillbirth of the competing risks model for SGA 7 and the stillbirth‐specific logistic regression model for placental dysfunction 1 was compared by the area under the ROC curve with 95% CI and by the detection rate with 95% CI at 10% FPR.…”

Section: Methodsmentioning

confidence: 99%

“…In 93% of the placental dysfunction related stillbirths, the birthweight was below the 10th centile of The Fetal Medicine Foundation population charts 1,2 . It may therefore be preferable to use one model for prediction of both SGA and stillbirth, rather than two separate models; the management of pregnancies at high risk for these conditions is essentially the same and involves serial ultrasound examinations for early diagnosis of SGA and then Doppler assessment of the fetal circulation to determine the best time and mode of delivery.…”

Section: Introductionmentioning

confidence: 99%

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Predictive performance for placental dysfunction related stillbirth of the competing risks model for small‐for‐gestational‐age fetuses

Nicolaides

Papastefanou

Syngelaki

et al. 2022

BJOG

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Objectives: To examine the predictive performance for placental dysfunction related stillbirths of the competing risks model for small-for-gestational-age (SGA) fetuses based on a combination of maternal risk factors, estimated fetal weight (EFW) and uterine artery pulsatility index (UtA-PI); and second, to compare the performance of this model with that of a stillbirth-specific model using the same biomarkers and with the Royal College of Obstetricians and Gynecologists (RCOG) guideline for the investigation and management of the SGA fetus.Design: Prospective observational study. Setting: Two UK maternity hospitals.Population: A total of 131 514 women with singleton pregnancies attending for routine ultrasound examination at 19-24 weeks of gestation. Methods:The predictive performance for stillbirth achieved by three models was compared.Main Outcome Measure: Placental dysfunction related stillbirth.Results: At 10% false-positive rate, the competing risks model predicted 59%, 66% and 71% of placental dysfunction related stillbirths, at any gestation, at <37 weeks and at <32 weeks, respectively, which were similar to the respective figures of 62%, 70% and 73% for the stillbirth-specific model. At a screen positive rate of 21.8%, as defined by the RCOG guideline, the competing risks model predicted 71%, 76% and 79% of placental dysfunction related stillbirths at any gestation, at <37 weeks and at <32 weeks, respectively, and the respective figures for the RCOG guideline were 40%, 44% and 42%. Conclusion:The predictive performance for placental dysfunction related stillbirths by the competing risks model for SGA was similar to that of the stillbirth-specific model and superior to that of the RCOG guideline.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive performance for placental dysfunction related stillbirth of the competing risks model for small‐for‐gestational‐age fetuses

Nicolaides

Papastefanou

Syngelaki

et al. 2022

BJOG

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“…In a previous study involving 131,514 of the pregnancies included in the current study, we reported that 92% of stillbirths were antepartum and 8% were intrapartum. About 60% of the antepartum stillbirths were thought to be due to impaired placentation, because the fetuses were small-for- gestational-age and/or the women had developed pre-eclampsia, and the other 40% were due to other causes or were unexplained [ 39 ]. Multivariable regression analysis showed that significant contribution to increased risk of impaired placentation-related stillbirths was provided by Black race, increasing body mass index, cigarette smoking, chronic hypertension, and previous pregnancy complicated by stillbirth, or preeclampsia or birth of small-for-gestational-age neonate.…”

Section: Discussionmentioning

confidence: 99%

Maternal Race and Stillbirth: Cohort Study and Systematic Review with Meta-Analysis

Arechvo

Nikolaidi

Gil

et al. 2022

JCM

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Accurate identification of independent predictors of stillbirth is needed to define preventive strategies. We aim to examine the independent contribution of maternal race in the risk of stillbirth after adjusting for maternal characteristics and medical history. There are two components to the study: first, prospective screening in 168,966 women with singleton pregnancies coordinated by the Fetal Medicine Foundation (FMF) and second, a systematic review and meta-analysis of studies reporting on race and stillbirth. In the FMF study, logistic regression analysis found that in black women, the risk of stillbirth, after adjustment for confounders, was higher than in white women (odds ratio 1.78, 95% confidence interval 1.50 to 2.11). The risk for other racial groups was not significantly different. The literature search identified 20 studies that provided data on over 6,500,000 pregnancies, but only 10 studies provided risks adjusted for some maternal characteristics; consequently, the majority of these studies did not provide accurate contribution of different racial groups to the prediction of stillbirth. It is concluded that in women of black origin, the risk of stillbirth, after adjustment for confounders, is about twofold higher than in white women. Consequently, closer surveillance should be granted for these women.

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“…Stillbirth constitutes a major tragedy in obstetrics and unfortunately, with current prenatal care many cases are unpredictable and, therefore, not preventable. However, extensive evidence suggests that first, about 60% of antepartum stillbirths are observed in association with placental dysfunction [ 17 ], and second, more than half of such stillbirths can be effectively identified in the first trimester based on screening by a combination of maternal characteristics, maternal serum PAPP-A, the uterine artery pulsatility index (UtA-PI), and the ductus venosus pulsatility index [ 18 , 19 ].…”

Section: Screening For Stillbirthmentioning

confidence: 99%

First Trimester Prediction of Adverse Pregnancy Outcomes—Identifying Pregnancies at Risk from as Early as 11–13 Weeks

2022

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There is consistent evidence that many of the pregnancy complications that occur late in the second and third trimester can be predicted from an integrated 11–13 weeks visit, where a maternal and fetal assessment are comprehensively performed. The traditional aims of the 11–13 weeks visit have been: establishing fetal viability, chorionicity and dating of the pregnancy, and performing the combined screening test for common chromosomal abnormalities. Recent studies have shown that the first trimester provides important information that may help to predict pregnancy complications, such as preeclampsia and fetal growth restriction, stillbirth, preterm birth, gestational diabetes mellitus and placenta accreta spectrum disorder. The aim of this manuscript is to review the methods available to identify pregnancies at risk for adverse outcomes after screening at 11–13 weeks. Effective screening in the first trimester improves pregnancy outcomes by allowing specific interventions such as administering aspirin and directing patients to specialist clinics for regular monitoring.

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Development and validation of model for prediction of placental dysfunction‐related stillbirth from maternal factors, fetal weight and uterine artery Doppler at mid‐gestation

Cited by 18 publications

References 38 publications

Predictive performance for placental dysfunction related stillbirth of the competing risks model for small‐for‐gestational‐age fetuses

Predictive performance for placental dysfunction related stillbirth of the competing risks model for small‐for‐gestational‐age fetuses

Maternal Race and Stillbirth: Cohort Study and Systematic Review with Meta-Analysis

First Trimester Prediction of Adverse Pregnancy Outcomes—Identifying Pregnancies at Risk from as Early as 11–13 Weeks

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